Strategies for Diabetes Management: Using Newer Oral Combination Therapies Early in the Disease

Zonszein, Joel; Groop, Per Henrik

doi:10.1007/s13300-016-0208-5

Cited by 22 publications

(12 citation statements)

References 84 publications

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“…Our results show medical inertia in the management of HF patients early after discharge. Inertia has been widely discussed in the context of hypertension or diabetes leading to a campaign of sensitization among practitioners [20][21][22]. In the area of HF, inertia between discharge and early follow-up has been discussed very little.…”

Section: Discussionmentioning

confidence: 99%

Medical Inertia in the Optimization of Heart Failure Treatment after Discharge and its Relationship to Outcome

Berthelot¹,

Jc²,

Salvat³

et al. 2018

Health Care Current Reviews

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Background: After discharge, patients with Acute Heart Failure (AHF) have a high risk of early re-admission and death. Many patients are discharged early before treatment has been optimized. By using a multicenter cohort of AHF patients, we analyzed changes in evidence-based HF medication between admission, discharge and early follow-up as well as their links to mortality. Methods:Clinical data and medications were collected during hospitalization. Changes in medication during the 3 months following discharge as well as the rate of all-cause mortality at one year were analyzed.Results: Among survivors at 3 months, 275 patients with LVEF ≤ 40% were included (age 72 ± 14 y). Between admission and discharge, usage of angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) and beta blocker (BB) increased by 19 to 20% and MRA by 8%. At discharge, ACE-I or ARB were prescribed in 80% of cases with the mean dose reaching 36 ± 31% of target dose, BB in 70% with the mean dose of 27 ± 51% of the target dose, mineraloreceptor antagonists (MRA) were prescribed in 23% and diuretics in 88% cases. Three months after discharge, there were few changes in medications. Start in ACE-I or ARB, beta-blockers and MRA was performed in 3 to 7% while cessation was performed in 5 to 6% cases. Changes in doses were observed in about 25% cases. usage of BB and Ace ORARB >/ % of target dose at 3 months shows a tendency to deusage montality [ HR=5,2999;95%ic1,7369-16-1722; p=0,0635]. Conclusion:Our data points out inertia in optimization of evidence-based HF medications after discharge and focus on potential explanations of such inertia. Medical ineatia have a potential impaction on outcomein heart failure. are numerous, including the patient's condition (age, comorbidities, adherence) as well as the physician's choices (ignorance of the guidelines, misgivings about new treatment, focus on patient symptoms rather than reduction of mortality), and access to health care [9][10][11][12][13][14]. However, data on changes in treatment over follow-up are scarce, particularly during the early follow-up of patients after an acute HF event. In order to bridge this gap of information by using a representative sample of AHF patients with reduced LVEF from a nationwide survey, we analyzed the usage of evidence-based HF medications on admission and discharge

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Section: Discussionmentioning

confidence: 99%

Medical Inertia in the Optimization of Heart Failure Treatment after Discharge and its Relationship to Outcome

Berthelot¹,

Jc²,

Salvat³

et al. 2018

Health Care Current Reviews

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“…4,6 Metformin and/or metformin extended release is available as a single-pill (ie, fixed-dose) combination with multiple other glucose-lowering agents, including sulfonylureas, thiazolidinediones, DPP-4 inhibitors, and SGLT2 inhibitors. 20 Although gastric tolerability with metformin can be a problem for some patients, this can be improved with appropriate dose up-titration over time or by changing to an extended-release formulation of metformin. 19 Although stringent restrictions regarding the use of metformin had been in place for patients with T2DM and chronic kidney disease because of an increased risk of lactic acidosis, the US Food and Drug Administration (FDA) recommended an update to the labeling of metformin-containing products in 2016.…”

Section: Biguanide: Metforminmentioning

confidence: 99%

Pharmacologic Management of Type 2 Diabetes Mellitus: Available Therapies

Thrasher¹

2017

The American Journal of Cardiology

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Choices for the treatment of type 2 diabetes mellitus (T2DM) have multiplied as our understanding of the underlying pathophysiologic defects has evolved. Treatment should target multiple defects in T2DM and follow a patient-centered approach that considers factors beyond glycemic control, including cardiovascular risk reduction. The American Association of Clinical Endocrinologists/American College of Endocrinology and the American Diabetes Association recommend an initial approach consisting of lifestyle changes and monotherapy, preferably with metformin. Therapy choices are guided by glycemic efficacy, safety profiles, particularly effects on weight and hypoglycemia risk, tolerability, patient comorbidities, route of administration, patient preference, and cost. Balancing management of hyperglycemia with the risk of hypoglycemia and consideration of the effects of pharmacotherapy on weight figure prominently in US-based T2DM recommendations, whereas less emphasis has been placed on the ability of specific medications to affect cardiovascular outcomes. This is likely because, until recently, specific glucose-lowering agents have not been shown to affect cardiorenal outcomes. The Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME), the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial, and the Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes 6 (SUSTAIN-6) recently showed a reduction in overall cardiovascular risk with empagliflozin, liraglutide, and semaglutide treatment, respectively. Moreover, empagliflozin has become the first glucose-lowering agent indicated to reduce the risk of cardiovascular death in adults with T2DM and established cardiovascular disease. Results from cardiovascular outcomes trials have prompted an update to the 2017 American Diabetes Association standards of care, which now recommend consideration of empagliflozin or liraglutide for patients with suboptimally controlled long-standing T2DM and established atherosclerotic cardiovascular disease because these agents have been shown to reduce cardiovascular and all-cause mortality when added to standard care.

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“…This has been attributed to an aging population2 and to lifestyle factors associated with westernization, such as sedentary behaviour and obesity 3, 4. Despite a comprehensive armamentarium of anti‐diabetic medications,5 the increasing prevalence of T2DM suggests that new treatments and regimens are still required.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of trelagliptin in combination with insulin therapy in Japanese patients with type 2 diabetes: Results from a randomized, Phase IV study

Kaku

Kuroda

Ishida

et al. 2018

Diabetes Obesity Metabolism

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We aimed to explore the efficacy and safety of once‐weekly trelagliptin 100 mg as an add‐on therapy to insulin in Japanese patients with type 2 diabetes mellitus with inadequate glycaemic control. Patients with haemoglobin A1c (HbA1c) 7.5% to 10.0% who were receiving 8 to 40 units of insulin per day were randomized to receive, with insulin, trelagliptin 100 mg (A/A, n = 116) or placebo (P/A, n = 124) for a 12‐week double‐blind (DB) phase, after which all received trelagliptin for a 40‐week open‐label phase. Primary endpoints were HbA1c change from baseline to the end of the DB phase and adverse events (AEs).HbA1c significantly decreased in the A/A group vs the P/A group at the end of the DB phase (least square mean difference, −0.63% [95% CI, −0.83 to −0.44]: P < .0001). The frequency of treatment‐emergent AEs during the DB phase was 44.0% in the A/A group and 47.6% in the P/A group. No patient experienced severe hypoglycaemia during trelagliptin treatment. Once‐weekly trelagliptin 100 mg therapy with insulin demonstrated a significant reduction in HbA1c. Long‐term treatment was well‐tolerated, with no clinically significant hypoglycaemia, suggesting that trelagliptin with insulin is a meaningful treatment option in this patient population.

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Strategies for Diabetes Management: Using Newer Oral Combination Therapies Early in the Disease

Cited by 22 publications

References 84 publications

Medical Inertia in the Optimization of Heart Failure Treatment after Discharge and its Relationship to Outcome

Medical Inertia in the Optimization of Heart Failure Treatment after Discharge and its Relationship to Outcome

Pharmacologic Management of Type 2 Diabetes Mellitus: Available Therapies

Efficacy and safety of trelagliptin in combination with insulin therapy in Japanese patients with type 2 diabetes: Results from a randomized, Phase IV study

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